Case Report Femoral Pathological Fracture as the First Clinical Manifestation of Papillary Thyroid Carcinoma in a Primigravida
|
|
- Joy Holmes
- 5 years ago
- Views:
Transcription
1 Case Reports in Pathology Volume 2013, Article ID , 4 pages Case Report Femoral Pathological Fracture as the First Clinical Manifestation of Papillary Thyroid Carcinoma in a Primigravida Ahmed Abu-Zaid, 1 Ayman Azzam, 2 Hindi Al-Hindi, 3 and Tarek Amin 2 1 College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Saudi Arabia 2 Department of Surgical Oncology, King Faisal Specialist Hospital and Research Center (KFSH&RC), P.O. Box 3354, Riyadh 11211, Saudi Arabia 3 Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center (KFSH&RC), P.O. Box 3354, Riyadh 11211, Saudi Arabia Correspondence should be addressed to Ahmed Abu-Zaid; aabuzaid@alfaisal.edu Received 23 February 2013; Accepted 24 March 2013 Academic Editors: T. Batinac, A. Handra-Luca, T. Hasebe, P. Tosi, T. Tot, and W. P. Wang Copyright 2013 Ahmed Abu-Zaid et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Papillary thyroid carcinoma is the most common differentiated type of thyroid malignancy. It is largely a loco-regional disease with a high tendency to metastasize to regional cervical lymph nodes. Distant hematogenous metastases are very rare and primarily include lungs and bones. Distant bone metastases are present in approximately 1.7% of patients with differentiated thyroid malignancy. Sternum, ribs, and spine are the most frequent sites of osseous metastases. Up to our knowledge, we report the first occurrence of an extra nodal metastasis of papillary thyroid carcinoma to a femoral bone presenting as a pathological fracture in a 21-year-old 37-week primigravida. We report this case because of its unusual site of metastasis and atypical presentation during pregnancy. Moreover, we briefly elaborate on the management of such uncommon cases. 1. Introduction Papillary thyroid carcinoma (PTC) is the most frequent differentiated histological form of thyroid malignancy accounting for approximately 80% of all primary thyroid cancers [1]. PTC is largely a localized disease confined to neck area with a high propensity to metastasize to regional cervical lymph nodes [2]. Hematogenous distant metastases from PTC are extremely rare [3].Atthetimeofdiagnosis,bonemetastases are present in less than 2% of all patients with differentiated thyroid malignancy [4].Sternum,ribs,andspinearethemost common locations of bone metastases [5]. Herein, we report an extra nodal metastasis of PTC to a femoral bone presenting as an incidental pathological fracture in a 21-year-old 37-week primigravida. 2. Case Report A 21-year-old 37-week primigravida was referred to our hospital with a femoral pathological fracture following a minor fall event at home. The patient was known to have goiter for three years. The goiter was predominately left-sided and stable with neither significant increase in size nor obstructive symptoms. Exposure to ionizing radiation and family history for thyroid malignancy were negative. Systemic review was remarkable for a one-week history of on/off back pain. The course of pregnancy was uneventful. Upon admission, laboratory work-up was significant for serum thyroglobulin (TG) of 1,368.0 μg/l (normal range: μg/l). Neck ultrasound (US) was done and showed a unifocal cm left-sided heteroechoic lesion involving the left thyroid lobe with moderately increased vascularity, foci of calcifications, and areas of necrosis. The neck US was highly suggestive of primary thyroid malignancy with no suspicious lymph nodes. Fine needle aspiration of the suspicious neck lesion confirmed the diagnosis of PTC. The patient was admitted for pregnancy delivery and further tumor work-up after delivery. Day-7 after admission, the patient delivered her baby at 38 weeks of gestation by an uneventful lower segment cesarean
2 2 Case Reports in Pathology (a) (b) Figure 1: Histopathological examination of the left thyroid lobe showing papillary thyroid carcinoma (H&E stain). (a) Tumor cells form follicles lined by cells with typical nuclear features of papillary thyroid carcinoma of crowded enlarged nuclei with prominent nuclear grooves. (b) There are several foci of vascular invasion. Note the endothelial lining of tumor emboli (arrows). section. The baby was otherwise healthy and placenta was not examined histologically for search of metastasis. After delivery, the patient was worked up for her femoral pathologicalfractureandqueryofmetastaticptc.computed tomography (CT) scan showed no evidence of lung metastasis or lymphadenopathy. Magnetic resonance imaging (MRI) scan showed destructive expansile osteolytic lesions involving the left proximal femur, the vertebral body of L2, and the right transverse process of T10. A multidisciplinary team was involved in the management of the patient. Patient underwent total thyroidectomy with left and central neck dissection. Grossly, the tumor was well circumscribed measuring 9.5 cm in the maximum diameter showing vascular invasion and without signs of invading surrounding tissues. Histopathological examination of the left thyroid lobe was consistent with primary PTC (Figure 1). All the twentynine reactive lymph nodes identified in the neck dissection specimen were negative for metastasis. Moreover, during the same surgery, the patient underwent left proximal femur resection with endoprosthesis. Histopathological examination of the resected proximal femur was consistent with metastatic PTC (Figure 2). Three months after left femur implantation, patient developed severe chronic prosthetic infection for 4 months which was managed aggressively with antibiotics. Two weeks after surgery, the patient underwent L2 vertebral body resection with posterior decompression (foraminotomy), interbody fusion, stabilization, and instrumentation. Histopathological examination of the resected L2 vertebral body was consistent with metastatic PTC. The surgical resection of the T10 mass was not a favorable option for three reasons: first, positive history of chronic left femur prosthetic infection; second, increased risk of metal chronic infection; third, the bloody nature of T10 tumor with possible life-threatening operative complications. Instead, the plan was to consider the patient for ten in-patient spine external beam radiation therapy (EBRT) sessions spread over two weeks without any further surgical intervention. Postoperatively, patient had a single session of radioactive iodine (I-131) therapy (dose: 190 mci). A follow-up US of Figure 2: Histopathological examination of the resected left femur showing a follicular pattern of papillary thyroid carcinoma (H&E stain). A bone spicule (b) is noted on the right side. necksofttissueshowedaclearrightthyroidbedandahypoechoicnoduleintheleftthyroidbedmeasuring0.4cminthe maximumdiameterwithnovascularityandnosuspicious lymph nodes. Postoperative thyroid function tests (TFTs) showednormalvaluesandtgdroppedto51.6μg/l (normal range: μg/l). Whole body positron emission tomography/computed tomography (PET/CT) scan showed interval resolution of neck findings with postoperative changes and multiple metastatic minimal fluorodeoxyglucose (FDG) avid bony lesions around the left total hip replacement prosthesis, L2 and T10. The patient was scheduled to be seen after 3 months. 3. Discussion PTC is the most common type of thyroid malignancy encountered in endocrinology clinics [1]. PTC can occur as a part of a familial syndrome (3%) or sporadically (97%) [6]. Exposure to ionizing radiation significantly increases theriskofdevelopingptc[7]. Although multifocality [8], bilaterality [9], and local lymphatic metastases [2] are very
3 Case Reports in Pathology 3 common features in PTC, interestingly, our patient had an unusual presentation of a unifocal and unilateral malignant lesion with no regional lymph node metastases at the time of diagnosis. PTC, as a largely localized slowly growing disease with an indolent clinical course, has a favorable prognosis and much lower cancer-related mortality rate than other malignancies [10]. Young age (less than 45 years) greatly influences staging and is a very significant positive prognostic factor in thyroid malignancy [3]. The presence of distant PTC angioinvasive metastases at the time of diagnosis is exceptionally rare and adversely affects prognosis and survival rate [11]. Distant bone metastases are present in approximately 1.7% of patients with differentiated thyroid malignancy [4]with the sternum, ribs, and spine being the most frequent sites of osseous metastases [5]. Distant metastases from primary PTC to femoral bones are broadly uncommon. Up to our knowledge, this is the first reported occurrence of an incidental femoral pathological fracture exhibiting metastatic PTC in a pregnancy setting. This suggests that PTC metastasis to an exceedingly uncommon site, such as a femoral bone with a resultant pathological fracture, may be the first manifestation of an incidental primary PTC presenting at the time of diagnosis. The presence of multiple extra nodal metastases of an advanced primary thyroid malignancy in the setting of a possibly tumor-aggravating factor such as pregnancy [12] presents a complicated management decision. Pregnancy may act as an aggravating factor in primary thyroid carcinoma. This is probably presumed via the role of human chorionic gonadotropin (β-hcg) hormone which may bind tothetshreceptorandstimulatefurthertumorproliferation [12]. Only less than 3% of pregnant women with PTC present with distant metastases at the time of diagnosis [13]. Up to our knowledge, the presented case report discloses the first occurrence of a femoral pathological fracture presenting in a pregnant woman with PTC. A well-judged management of such cases requires consideration of three issues. First, postponement of the surgicalinterventionofptcdiagnosedlateinanuneventful pregnancy: the prognosis of primary or metastatic thyroid malignancy in pregnant and nonpregnant women does not seem to be dramatically different, and the surgical intervention of primary or metastatic thyroid carcinoma diagnosed late in the course of pregnancy can be postponed safely until after labor [13]. Second, consideration of extensive thyroid surgical clearance (total thyroidectomy and radical neck dissection) followed by ablative radioactive iodine (I-131) treatment: the mainstay treatment of differentiated thyroid malignancy remains surgical resection followed by ablative I-131 and postoperative thyroid-stimulating hormone (TSH) suppression. Third, consideration of instantaneous resection of operable solitary bone metastases with or without subsequent external beam radiation therapy (EBRT): the use of I-131 in the treatment of metastatic PTC bone lesion is not effective (suboptimal) and does not yield complete response [14]. Conversely, the use of EBRT has been strongly suggested in the management of loco-regional gross/microscopic residual disease after surgical resection [15] as well as in the management of inoperable bone metastases in patients with PTC [16]. Successful management of such complex clinical cases requires involvement of a multidisciplinary team and such patients should be thoroughly investigated and followed up for cancer recurrence. 4. Conclusion To the best of our knowledge, we report the first occurrence of an extra nodal metastasis of PTC to a femoral bone presenting as a pathological fracture in a pregnant woman. Metastasis of thyroid carcinoma should always be considered in the differential diagnosis of pathological fracture in any patient presenting with a history of thyroid malignancy, and histopathological examination of the bone specimen is essential for confirming the diagnosis. Successful management of such complex clinical cases requires involvement of a multidisciplinary team. Acknowledgment The authors sincerely acknowledge the editorial assistance of Ms. Tehreem Khan and Ms. Ranim Chamseddin, College of Medicine,AlfaisalUniversity,Riyadh,SaudiArabia. References [1] S. A. Hundahl, I. D. Fleming, A. M. Fremgen, and H. R. Menck, A National Cancer Data Base report on 53, 856 cases of thyroid carcinoma treated in the U.S., , Cancer, vol. 83, no. 12, pp , [2] G. L. Clayman, T. D. Shellenberger, L. E. Ginsberg et al., Approach and safety of comprehensive central compartment dissection in patients with recurrent papillary thyroid carcinoma, Head and Neck, vol. 31, no. 9, pp , [3] M. Shoup, A. Stojadinovic, A. Nissan et al., Prognostic indicators of outcomes in patients with distant metastases from differentiated thyroid carcinoma, the American College of Surgeons,vol.197,no.2,pp ,2003. [4] J.J.Ruegemer,I.D.Hay,E.J.Bergstralh,J.J.Ryan,K.P.Offord, and C. A. Gorman, Distant metastases in differentiated thyroid carcinoma: a multivariate analysis of prognostic variables, Clinical Endocrinology and Metabolism, vol.67,no. 3, pp , [5] G. Zettinig, B. J. Fueger, C. Passler et al., Long-term followup of patients with bone metastases from differentiated thyroid carcinoma surgery or conventional therapy? Clinical Endocrinology,vol.56,no.3,pp ,2002. [6] D. E. Goldgar, D. F. Easton, L. A. Cannon-Albright, and M. H. Skolnick, Systematic population-based assessment of cancer risk in first-degree relatives of cancer probands, the National Cancer Institute, vol. 86, no. 21, pp , [7] E. Ron, Ionizing radiation and cancer risk: evidence from epidemiology, Radiation Research,vol.150,no.5,pp.S30 S41, [8] W.O.Russell,M.L.Ibanez,R.L.Clark,andE.C.White, Thyroid carcinoma. Classification, intraglandular dissemination, and clinicopathological study based upon whole organ sections of 80 glands, Cancer,vol.16,pp ,1963.
4 4 Case Reports in Pathology [9]R.Katoh,J.Sasaki,H.Kurihara,K.Suzuki,Y.Iida,andA. Kawaoi, Multiple thyroid involvement (intraglandular metastasis) in papillary thyroid carcinoma: a clinicopathologic study of 105 consecutive patients, Cancer,vol.70,no.6,pp , [10] S. F. Dinneen, M. J. Valimaki, E. J. Bergstralh, J. R. Goellner, C. A. Gorman, and I. D. Hay, Distant metastases in papillary thyroid carcinoma: 100 Cases observed at one institution during 5 decades, Clinical Endocrinology and Metabolism, vol.80,no.7,pp ,1995. [11] M. R. Pelizzo, I. M. Boschin, A. Toniato et al., Papillary thyroid carcinoma: 35-Year outcome and prognostic factors in 1858 patients, Clinical Nuclear Medicine, vol. 32, no. 6, pp , [12] H. M. Foster and S. N. Sinha, Pregnancy and thyroid cancer two case reports and a review of the current literature, Papua andnewguineamedicaljournal,vol.31,no.4,pp , [13] M. Moosa and E. L. Mazzaferri, Outcome of differentiated thyroid cancer diagnosed in pregnant women, Clinical Endocrinology and Metabolism,vol.82,no.9,pp , [14] C. A. G. Proye, D. H. R. Dromer, B. M. Carnaille et al., Is it still worthwhile to treat bone metastases from differentiated thyroid carcinoma with radioactive iodine? World Surgery, vol.16,no.4,pp ,1992. [15] G. E. Sheline, M. Galante, and S. Lindsay, Radiation therapy in the control of persistent thyroid cancer, The American Journal of Roentgenology, Radium Therapy, and Nuclear Medicine, vol. 97, no. 4, pp , [16]J.Brierley,R.Tsang,T.Panzarella,andN.Bana, Prognostic factors and the effect of treatment with radioactive iodine and external beam radiation on patients with differentiated thyroid cancer seen at a single institution over 40 years, Clinical Endocrinology,vol.63,no.4,pp ,2005.
5 MEDIATORS of INFLAMMATION The Scientific World Journal Gastroenterology Research and Practice Diabetes Research International Endocrinology Immunology Research Disease Markers Submit your manuscripts at BioMed Research International PPAR Research Obesity Ophthalmology Evidence-Based Complementary and Alternative Medicine Stem Cells International Oncology Parkinson s Disease Computational and Mathematical Methods in Medicine AIDS Behavioural Neurology Research and Treatment Oxidative Medicine and Cellular Longevity
Mandana Moosavi 1 and Stuart Kreisman Background
Case Reports in Endocrinology Volume 2016, Article ID 6471081, 4 pages http://dx.doi.org/10.1155/2016/6471081 Case Report A Case Report of Dramatically Increased Thyroglobulin after Lymph Node Biopsy in
More informationCase Report Renal Cell Carcinoma Metastatic to Thyroid Gland, Presenting Like Anaplastic Carcinoma of Thyroid
Case Reports in Urology Volume 2013, Article ID 651081, 4 pages http://dx.doi.org/10.1155/2013/651081 Case Report Renal Cell Carcinoma Metastatic to Thyroid Gland, Presenting Like Anaplastic Carcinoma
More informationMulti-Organ Distant Metastases in Follicular Thyroid Cancer- Rare Case Report
Multi-Organ Distant Metastases in Follicular Thyroid Cancer- Rare Case Report Dr. Mohammed Raza 1, Dr. Sindhuri K 2, Dr. Dinesh Reddy Y 3 1 Professor, Department of Surgery, JSS University, Mysore, India
More informationResearch Article Papillary Thyroid Cancer, Macrofollicular Variant: The Follow-Up and Analysis of Prognosis of 5 Patients
yroid Research, Article ID 818134, 4 pages http://dx.doi.org/10.1155/2014/818134 Research Article Papillary Thyroid Cancer, Macrofollicular Variant: The Follow-Up and Analysis of Prognosis of 5 Patients
More informationCase Report Five-Year Survival after Surgery for Invasive Micropapillary Carcinoma of the Stomach
Case Reports in Surgery Volume 2013, Article ID 560712, 4 pages http://dx.doi.org/10.1155/2013/560712 Case Report Five-Year Survival after Surgery for Invasive Micropapillary Carcinoma of the Stomach Shigeo
More informationCase Report PET/CT Imaging in Oncology: Exceptions That Prove the Rule
Case Reports in Oncological Medicine Volume 2013, Article ID 865032, 4 pages http://dx.doi.org/10.1155/2013/865032 Case Report PET/CT Imaging in Oncology: Exceptions That Prove the Rule M. Casali, 1 A.
More informationDifferentiated Thyroid Cancer: Initial Management
Page 1 ATA HOME GIVE ONLINE ABOUT THE ATA JOIN THE ATA MEMBER SIGN-IN INFORMATION FOR PATIENTS FIND A THYROID SPECIALIST Home Management Guidelines for Patients with Thyroid Nodules and Differentiated
More informationThyroid Nodule. Disclosure. Learning Objectives P A P A P A 3/18/2014. Nothing to disclose.
Thyroid Nodule Evaluating the patient with a thyroid nodule and some management options. Miguel V. Valdez PA C Disclosure Nothing to disclose. Learning Objectives Examination of thyroid gland Options for
More informationOsman Ilkay Ozdamar, 1 Gul Ozbilen Acar, 1 Cigdem Kafkasli, 1 M. Tayyar Kalcioglu, 1 Tulay Zenginkinet, 2 and H. Gonca Tamer 3. 1.
Case Reports in Otolaryngology Volume 2015, Article ID 79658, 4 pages http://dx.doi.org/10.1155/2015/79658 Case Report Papillary Thyroid Microcarcinoma with a Large Cystic Dilated Lymph Node Metastasis
More informationCase Report Unexpected Bone Metastases from Thyroid Cancer
Case Reports in Endocrinology Volume 2015, Article ID 434732, 4 pages http://dx.doi.org/10.1155/2015/434732 Case Report Unexpected Bone Metastases from Thyroid Cancer Sandra Gibiezaite, 1 Savas Ozdemir,
More informationCase Report A Case of Primary Submandibular Gland Oncocytic Carcinoma
Case Reports in Otolaryngology Volume 2013, Article ID 384238, 4 pages http://dx.doi.org/10.1155/2013/384238 Case Report A Case of Primary Submandibular Gland Oncocytic Carcinoma Kunihiko Tokashiki, Kiyoaki
More informationCase Report Treatment of Ipilimumab Induced Graves Disease in a Patient with Metastatic Melanoma
Case Reports in Endocrinology Volume 2016, Article ID 2087525, 4 pages http://dx.doi.org/10.1155/2016/2087525 Case Report Treatment of Ipilimumab Induced Graves Disease in a Patient with Metastatic Melanoma
More informationSolitary Contralateral Adrenal Metastases after Nephrectomy for Renal Cell Carcinoma
Original Report ISSN 1537-744X; DOI 10.1100/tsw.2004.39 Solitary Contralateral Adrenal after Nephrectomy for Renal Cell Carcinoma Nikolaos Antoniou, M.D. and Demetrios Karanastasis, M.D. General Hospital
More information42 yr old male with h/o Graves disease and prior I 131 treatment presents with hyperthyroidism and undetectable TSH. 2 hr uptake 20%, 24 hr uptake 50%
Pinhole images of the neck are acquired in multiple projections, 24hrs after the oral administration of approximately 200 µci of I123. Usually, 24hr uptake value if also calculated (normal 24 hr uptake
More informationR. F. Falkenstern-Ge, 1 S. Bode-Erdmann, 2 G. Ott, 2 M. Wohlleber, 1 and M. Kohlhäufl Introduction. 2. Histology
Case Reports in Oncological Medicine Volume 2013, Article ID 167585, 4 pages http://dx.doi.org/10.1155/2013/167585 Case Report Late Lung Metastasis of a Primary Eccrine Sweat Gland Carcinoma 10 Years after
More informationCase Report Metastatic Malignant Melanoma of Parotid Gland with a Regressed Primary Tumor
Case Reports in Otolaryngology Volume 2016, Article ID 5393404, 4 pages http://dx.doi.org/10.1155/2016/5393404 Case Report Metastatic Malignant Melanoma of Parotid Gland with a Regressed Primary Tumor
More informationPre-operative Ultrasound of Lymph Nodes in Thyroid Cancer
Pre-operative Ultrasound of Lymph Nodes in Thyroid Cancer AACE - Advances in Medical and Surgical Management of Thyroid Cancer - 2018 Robert A. Levine, MD, FACE, ECNU Thyroid Center of New Hampshire Geisel
More informationDistant and Lymph Node Metastases of Thyroid Nodules with No Pathological Evidence of Malignancy: A Limitation of Pathological Examination
Endocrine Journal 2008, 55 (5), 889 894 Distant and Lymph Node Metastases of Thyroid Nodules with No Pathological Evidence of Malignancy: A Limitation of Pathological Examination YASUHIRO ITO, TOMONORI
More informationB. Environmental Factors. a. The major risk factor to papillary thyroid cancer is exposure to ionizing radiation, during the first 2 decades of life.
B. Environmental Factors. a. The major risk factor to papillary thyroid cancer is exposure to ionizing radiation, during the first 2 decades of life. b. Deficiency of dietary iodine: - Is linked with a
More informationCase Report Pancreas as Delayed Site of Metastasis from Papillary Thyroid Carcinoma
Case Reports in Gastrointestinal Medicine Volume 2013, Article ID 386263, 4 pages http://dx.doi.org/10.1155/2013/386263 Case Report Pancreas as Delayed Site of Metastasis from Papillary Thyroid Carcinoma
More informationAdjuvant therapy for thyroid cancer
Carcinoma of the thyroid Adjuvant therapy for thyroid cancer John Hay Department of Radiation Oncology Vancouver Cancer Centre Department of Surgery UBC 1% of all new malignancies 0.5% in men 1.5% in women
More informationCase Report Denosumab Chemotherapy for Recurrent Giant-Cell Tumor of Bone: A Case Report of Neoadjuvant Use Enabling Complete Surgical Resection
Case Reports in Oncological Medicine Volume 2013, Article ID 496351, 4 pages http://dx.doi.org/10.1155/2013/496351 Case Report Denosumab Chemotherapy for Recurrent Giant-Cell Tumor of Bone: A Case Report
More information4/22/2010. Hakan Korkmaz, MD Assoc. Prof. of Otolaryngology Ankara Dıșkapı Training Hospital-Turkey.
Management of Differentiated Thyroid Cancer: Head Neck Surgeon Perspective Hakan Korkmaz, MD Assoc. Prof. of Otolaryngology Ankara Dıșkapı Training Hospital-Turkey Thyroid gland Small endocrine gland:
More informationCase Report Tumor-to-Tumor Metastasis: Lung Carcinoma Metastasizing to Thyroid Neoplasms
Case Reports in Pathology Volume 2015, Article ID 153932, 5 pages http://dx.doi.org/10.1155/2015/153932 Case Report Tumor-to-Tumor Metastasis: Lung Carcinoma Metastasizing to Thyroid Neoplasms Shiuan-Li
More informationCase Scenario 1: Thyroid
Case Scenario 1: Thyroid History and Physical Patient is an otherwise healthy 80 year old female with the complaint of a neck mass first noticed two weeks ago. The mass has increased in size and is palpable.
More informationThyroid Pathology: It starts and ends with the gross. Causes of Thyrophobia. Agenda. Diagnostic ambiguity. Treatment/prognosis disconnect
Thyroid Pathology: It starts and ends with the gross Jennifer L. Hunt, MD, MEd Aubrey J. Hough Jr, MD, Endowed Professor of Pathology Chair of Pathology and Laboratory Medicine University of Arkansas for
More informationCase Report A Rare Cutaneous Adnexal Tumor: Malignant Proliferating Trichilemmal Tumor
Case Reports in Medicine Volume 2015, Article ID 742920, 4 pages http://dx.doi.org/10.1155/2015/742920 Case Report A Rare Cutaneous Adnexal Tumor: Malignant Proliferating Trichilemmal Tumor Omer Alici,
More informationUltrasound for Pre-operative Evaluation of Well Differentiated Thyroid Cancer
Ultrasound for Pre-operative Evaluation of Well Differentiated Thyroid Cancer Its Not Just About the Nodes AACE Advances in Medical and Surgical Management of Thyroid Cancer - 2017 Robert A. Levine, MD,
More informationPapillary Thyroid Microcarcinoma Presenting as Horner s Syndrome: A Novel Clinical Presentation
Case Report American Journal of Cancer Case Reports http://ivyunion.org/index.php/ajccr/ Page 1 of 6 Papillary Thyroid Microcarcinoma Presenting as Horner s Syndrome: A Novel Clinical Presentation Ammara
More informationPEDIATRIC Ariel Katz MD
PEDIATRIC Ariel Katz MD Dept. Otolaryngology Head &Neck Surgery Wolfson Medical Center Holon, Israel OBJECTIVES Overview/Background Epidemiology/Etiology Intro to Guidelines Workup Treatment Follow-Up
More informationAGGRESSIVE VARIANTS OF PAPILLARY THYROID CARCINOMA DIAGNOSIS AND PROGNOSIS
AGGRESSIVE VARIANTS OF PAPILLARY THYROID CARCINOMA DIAGNOSIS AND PROGNOSIS PAPILLARY THYROID CARCINOMA Clinical Any age Microscopic to large Female: Male= 2-4:1 Radiation history Lymph nodes Prognosis
More informationAn Unexpected Cause of Hypoglycemia
An Unexpected Cause of Hypoglycemia Stacey A. Milan, MD FACS Surgical Oncology Nothing to disclose Disclosures Objectives Identify indications for workup of hypoglycemia Define work up for hypoglycemic
More informationCase Report Overlap of Acute Cholecystitis with Gallstones and Squamous Cell Carcinoma of the Gallbladder in an Elderly Patient
Case Reports in Surgery Volume 2015, Article ID 767196, 4 pages http://dx.doi.org/10.1155/2015/767196 Case Report Overlap of Acute Cholecystitis with Gallstones and Squamous Cell Carcinoma of the Gallbladder
More informationA variation in recurrence patterns of papillary thyroid cancer with disease progression: A long-term follow-up study
ORIGINAL ARTICLE A variation in recurrence patterns of papillary thyroid cancer with disease progression: A long-term follow-up study Joon-Hyop Lee, MD, Yoo Seung Chung, MD, PhD,* Young Don Lee, MD, PhD
More informationClinical Study Metastasectomy of Pulmonary Metastases from Osteosarcoma: Prognostic Factors and Indication for Repeat Metastasectomy
Respiratory Medicine Volume 2015, Article ID 570314, 5 pages http://dx.doi.org/10.1155/2015/570314 Clinical Study Metastasectomy of Pulmonary Metastases from Osteosarcoma: Prognostic Factors and Indication
More informationResearch Article A Study on Central Lymph Node Metastasis in 543 cn0 Papillary Thyroid Carcinoma Patients
International Endocrinology Volume 2016, Article ID 1878194, 5 pages http://dx.doi.org/10.1155/2016/1878194 Research Article A Study on Central Lymph Node Metastasis in 543 cn0 Papillary Thyroid Carcinoma
More informationClinical Study Mucosal Melanoma in the Head and Neck Region: Different Clinical Features and Same Outcome to Cutaneous Melanoma
ISRN Dermatology Volume 2013, Article ID 586915, 5 pages http://dx.doi.org/10.1155/2013/586915 Clinical Study Mucosal Melanoma in the Head and Neck Region: Different Clinical Features and Same Outcome
More informationFollicular thyroid carcinoma presenting as solitary liver metastasis: a case report
Battoo et al. Journal of Medical Case Reports (2016) 10:347 DOI 10.1186/s13256-016-1140-z CASE REPORT Open Access Follicular thyroid carcinoma presenting as solitary liver metastasis: a case report Azhar
More informationManagement of Neck Metastasis from Unknown Primary
Management of Neck Metastasis from Unknown Primary.. Definition Histologic evidence of malignancy in the cervical lymph node (s) with no apparent primary site of original tumour Diagnosis after a thorough
More informationReoperative central neck surgery
Reoperative central neck surgery R. Pandev, I. Tersiev, M. Belitova, A. Kouizi, D. Damyanov University Clinic of Surgery, Section Endocrine Surgery University Hospital Queen Johanna ISUL Medical University
More informationWTC 2013 Panel Discussion: Minimal disease
WTC 2013 Panel Discussion: Minimal disease Susan J. Mandel MD MPH Panelists Ken Ain Yasuhiro Ito Stephanie Lee Erich Sturgis Mark Urken Faculty/Presenter Disclosure Relationships with commercial interests
More informationCase Report Internal Jugular Vein Thrombosis in Isolated Tuberculous Cervical Lymphadenopathy
Volume 2016, Article ID 5184196, 4 pages http://dx.doi.org/10.1155/2016/5184196 Case Report Internal Jugular Vein Thrombosis in Isolated Tuberculous Cervical Lymphadenopathy Sanjay Khaladkar, Avadhesh
More informationCalcitonin. 1
Calcitonin Medullary thyroid carcinoma (MTC) is characterized by a high concentration of serum calcitonin. Routine measurement of serum calcitonin concentration has been advocated for detection of MTC
More informationTHYROID CANCER IN CHILDREN. Humberto Lugo-Vicente MD FACS FAAP Professor Pediatric Surgery UPR School of Medicine
THYROID CANCER IN CHILDREN Humberto Lugo-Vicente MD FACS FAAP Professor Pediatric Surgery UPR School of Medicine Thyroid nodules Rare Female predominance 4-fold as likely to be malignant Hx Radiation exposure?
More informationDr J K Jekel Dept. Surgery University of Pretoria
Dr J K Jekel Dept. Surgery University of Pretoria No Maybe ( T`s and C`s apply ) 1. Total thyroidectomy 2. Neck dissection only if nodes are involved 3. Ablative dose or doses of Radioactive Iodine 4.
More informationClinical Study Prognosis of Multifocal Papillary Thyroid Carcinoma
International Endocrinology, Article ID 89382, 6 pages http://dx.doi.org/1.11/213/89382 Clinical Study Prognosis of Multifocal Papillary Thyroid Carcinoma Sheng-Fong Kuo, 1 Shu-Fu Lin, 1 Tzu-Chieh Chao,
More informationManagement guideline for patients with differentiated thyroid cancer. Teeraporn Ratanaanekchai ENT, KKU 17 October 2007
Management guideline for patients with differentiated thyroid Teeraporn Ratanaanekchai ENT, KKU 17 October 2007 Incidence (Srinagarind Hospital, 2005, both sex) Site (all) cases % 1. Liver 1178 27 2. Lung
More informationIntroduction. Materials and methods Y-N XU 1,2, J-D WANG 1,2
1 di 5 11/04/2016 17:54 G Chir Vol. 31 - n. 5 - pp. 205-209 Maggio 2010 Y-N XU 1,2, J-D WANG 1,2 Introduction The World Health Organization (WHO) defined papillary thyroid microcarcinomas (PTMC) as tumors
More informationEvaluation and Management of Thyroid Nodules. Nick Vernetti, MD, FACE Palm Medical Group Las Vegas, Nevada
Evaluation and Management of Thyroid Nodules Nick Vernetti, MD, FACE Palm Medical Group Las Vegas, Nevada Disclosure Consulting Amgen Speaking Amgen Objectives Understand the significance of incidental
More informationIndex. Surg Oncol Clin N Am 16 (2007) Note: Page numbers of article titles are in boldface type.
Surg Oncol Clin N Am 16 (2007) 465 469 Index Note: Page numbers of article titles are in boldface type. A Adjuvant therapy, preoperative for gastric cancer, staging and, 339 B Breast cancer, metabolic
More informationGastric Signet-Ring Cell Carcinoma: Unilateral Lower Extremity Lymphoedema as the Presenting Feature
Clinical Image TheScientificWorldJOURNAL (2007) 7, 1189 1192 ISSN 1537-744X; DOI 10.1100/tsw.2007.199 Gastric Signet-Ring Cell Carcinoma: Unilateral Lower Extremity Lymphoedema as the Presenting Feature
More information2015 American Thyroid Association Thyroid Nodule and Cancer Guidelines
2015 American Thyroid Association Thyroid Nodule and Cancer Guidelines Angela M. Leung, MD, MSc, ECNU November 5, 2016 Outline Workup of nontoxic thyroid nodule(s) Ultrasound FNAB Management of FNAB results
More informationCase Report Two Cases of Small Cell Cancer of the Maxillary Sinus Treated with Cisplatin plus Irinotecan and Radiotherapy
Case Reports in Otolaryngology Volume 2013, Article ID 893638, 4 pages http://dx.doi.org/10.1155/2013/893638 Case Report Two Cases of Small Cell Cancer of the Maxillary Sinus Treated with Cisplatin plus
More informationCase Report Tortuous Common Carotid Artery: A Report of Four Cases Observed in Cadaveric Dissections
Case Reports in Otolaryngology Volume 2016, Article ID 2028402, 4 pages http://dx.doi.org/10.1155/2016/2028402 Case Report Tortuous Common Carotid Artery: A Report of Four Cases Observed in Cadaveric Dissections
More information5/3/2017. Ahn et al N Engl J Med 2014; 371
Alan Failor, M.D. Clinical Professor of Medicine Division of Metabolism, Endocrinology and Nutrition University of Washington April 20, 2017 No disclosures to report 1. Appropriately evaluate s in adult
More informationPediatric Thyroid Cancer Lung Metastases. Liora Lazar MD
Pediatric Thyroid Cancer Lung Metastases Liora Lazar MD Differentiated thyroid cancer (DTC) The 3rd most common solid tumor in childhood and adolescence Accounting for 1.5%-3% of all childhood cancers
More informationPapillary Thyroid Carcinoma Presented with Huge Bone Metastases Right Ileum and Frontal Bones
CASE REPORT Papillary Thyroid Carcinoma Presented with Huge Bone Metastases Right Ileum and Frontal Bones Fatima Begum, Sadia Sultana, Nabeel Fahmi Ali, Mohshi Um Mokaddema, Nurun Nahar National Institute
More information- RET/PTC rearrangement: 20% papillary thyroid cancer - RET: medullary thyroid cancer
Thyroid Cancer UpToDate: Introduction: Risk Factors: Biology: Symptoms: Diagnosis: 1. Lenvina is the first line therapy with powerful durable response and superior PFS in pts with RAI-refractory disease.
More informationProf. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C.
Role of Whole-body Diffusion MR in Detection of Metastatic lesions Prof. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C. Cancer is a potentially life-threatening disease,
More informationAn unusual presentation of papillary thyroid carcinoma in the lateral aspect of the neck
www.edoriumjournals.com Case report peer REVIEWED OPEN ACCESS An unusual presentation of papillary thyroid carcinoma in the lateral aspect of the neck Ghassan Almaimani, Frank Forst, Thomas Zoedler, Bayan
More informationWomen s Health in General Practice Symposium 2015 Thyroid & Parathyroid Cases
Women s Health in General Practice Symposium 2015 Thyroid & Parathyroid Cases Bill Fleming Epworth Freemasons Hospital 1 Common Endocrine Presentations anatomical problems thyroid nodule / goitre embryological
More informationCase Report Durable Effect of Radioactive Iodine in a Patient with Metastatic Follicular Thyroid Carcinoma
Case Reports in Endocrinology Volume 2012, Article ID 231912, 5 pages doi:10.1155/2012/231912 Case Report Durable Effect of Radioactive Iodine in a Patient with Metastatic Follicular Thyroid Carcinoma
More informationCase Report Pulmonary Hilar Tumor: An Unusual Presentation of Sclerosing Hemangioma
Volume 2016, Article ID 8919012, 4 pages http://dx.doi.org/10.1155/2016/8919012 Case Report Pulmonary Hilar Tumor: An Unusual Presentation of Sclerosing Hemangioma Jui-Hung Hung, Ching Hsueh, Chiung-Ying
More informationThyroid nodules - medical and surgical management. Endocrinology and Endocrine Surgery Manchester Royal Infirmary
Thyroid nodules - medical and surgical management JRE Davis NR Parrott Endocrinology and Endocrine Surgery Manchester Royal Infirmary Thyroid nodules - prevalence Thyroid nodules common, increase with
More informationLocally advanced papillary thyroid cancer
Locally advanced papillary thyroid cancer Educational Session 12 th October 2015 Presenters: Smith JA, Carr-Boyd E Supervisors: Palme CE, Elliott M, Navin N, Gupta R Content Case report Imaging Primary
More informationRadiology Pathology Conference
Radiology Pathology Conference Sharlin Johnykutty,, MD, Cytopathology Fellow Sara Majewski, MD, Radiology Resident Friday, August 28, 2009 Presentation material is for education purposes only. All rights
More informationHow good are we at finding nodules? Thyroid Nodules Thyroid Cancer Epidemiology Initial management Long-term follow up Disease-free status
New Perspectives in Thyroid Cancer Jennifer Sipos, MD Assistant Professor of Medicine Division of Endocrinology The Ohio State University Outline Thyroid Nodules Thyroid Cancer Epidemiology Initial management
More informationGerard M. Doherty, MD
Surgical Management of Differentiated Thyroid Cancer: Update on 2015 ATA Guidelines Gerard M. Doherty, MD Chair of Surgery Utley Professor of Surgery and Medicine Boston University Surgeon-in-Chief Boston
More informationLong-term Follow-up for Patients with Papillary Thyroid Carcinoma Treated as Benign Nodules
Long-term Follow-up for Patients with Papillary Thyroid Carcinoma Treated as Benign Nodules YASUHIRO ITO, TAKUYA HIGASHIYAMA, YUUKI TAKAMURA, AKIHIRO MIYA, KAORU KOBAYASHI, FUMIO MATSUZUKA, KANJI KUMA
More informationShifting Paradigms and Debates in the Management of Well-differentiated Thyroid Cancer
DEBATE WJOES Shifting Paradigms and Debates in the Management of Well-differentiated Thyroid Cancer Shifting Paradigms and Debates in the Management of Well-differentiated Thyroid Cancer Ashok R Shaha
More informationCase Report Multiple Giant Cell Tumors of Tendon Sheath Found within a Single Digit of a 9-Year-Old
Case Reports in Orthopedics Volume 2016, Article ID 1834740, 4 pages http://dx.doi.org/10.1155/2016/1834740 Case Report Multiple Giant Cell Tumors of Tendon Sheath Found within a Single Digit of a 9-Year-Old
More informationPrognostic Evaluation of Patients With Multicentric Papillary Thyroid Microcarcinoma
Volume 110 Number 8 August 2011 Formosan Medical Association Taipei, Taiwan ISSN 0929 6646 Resveratrol for prophylaxis of ischemic stroke Microglia and chronic pain ART in HIV-1-discordant couples in Taiwan
More informationCase Report Osteolysis of the Greater Trochanter Caused by a Foreign Body Granuloma Associated with the Ethibond Suture after Total Hip Arthroplasty
Hindawi Volume 2017, Article ID 6082302, 4 pages https://doi.org/10.1155/2017/6082302 Case Report Osteolysis of the Greater Trochanter Caused by a Foreign Body Granuloma Associated with the Ethibond Suture
More informationCase Report Primary Neuroendocrine Carcinoma of Ocular Adnexa
Volume 2013, Article ID 281351, 4 pages http://dx.doi.org/10.1155/2013/281351 Case Report Primary Neuroendocrine Carcinoma of Ocular Adnexa Daisuke Yamanouchi, 1 Toshiyuki Oshitari, 1 Yosuke Nakamura,
More informationRadiology- Pathology Conference 4/29/2012. Lymph Nodes. John McGrath
Radiology- Pathology Conference 4/29/2012 Lymph Nodes John McGrath 1 Presentation material is for education purposes only. All rights reserved. 2012 URMC Radiology Page 1 of 24 Case 1: 51 year-old male
More informationCase Report Tumor-to-Tumor Metastasis: Lung Carcinoma Metastasizing to Thyroid Neoplasms
Hindawi Publishing Corporation Volume 2015, Article ID 153932, 5 pages http://dx.doi.org/10.1155/2015/153932 Case Report Tumor-to-Tumor Metastasis: Lung Carcinoma Metastasizing to Thyroid Neoplasms Shiuan-Li
More informationCase Report Intracranial Capillary Hemangioma in the Posterior Fossa of an Adult Male
Case Reports in Radiology Volume 2016, Article ID 6434623, 4 pages http://dx.doi.org/10.1155/2016/6434623 Case Report Intracranial Capillary Hemangioma in the Posterior Fossa of an Adult Male Jordan Nepute,
More informationDynamic Risk Stratification:
Dynamic Risk Stratification: Using Risk Estimates to Guide Initial Management R Michael Tuttle, MD Clinical Director, Endocrinology Service Memorial Sloan Kettering Cancer Center Professor of Medicine
More informationUnusual Osteoblastic Secondary Lesion as Predominant Metastatic Disease Spread in Two Cases of Uterine Leiomyosarcoma
49 Unusual Osteoblastic Secondary Lesion as Predominant Metastatic Disease Spread in Two Cases of Uterine Leiomyosarcoma Loredana Miglietta a Maria Angela Parodi b Luciano Canobbio b Luca Anselmi c a Medical
More informationThyroid INTRODUCTION ANATOMY SUMMARY OF CHANGES
AJC 7/14/06 1:19 PM Page 67 Thyroid C73.9 Thyroid gland SUMMARY OF CHANGES Tumor staging (T) has been revised and the categories redefined. T4 is now divided into T4a and T4b. Nodal staging (N) has been
More informationCase Report Pediatric Transepiphyseal Seperation and Dislocation of the Femoral Head
Case Reports in Orthopedics Volume 2013, Article ID 703850, 4 pages http://dx.doi.org/10.1155/2013/703850 Case Report Pediatric Transepiphyseal Seperation and Dislocation of the Femoral Head Mehmet Elmadag,
More informationKentaro Tanaka, 1 Hiroki Mori, 1 Mutsumi Okazaki, 1 Aya Nishizawa, 2 and Hiroo Yokozeki Introduction. 2. Case Presentation
Case Reports in Oncological Medicine Volume 2013, Article ID 259326, 4 pages http://dx.doi.org/10.1155/2013/259326 Case Report Long-Term Treatment Outcome after Only Popliteal Lymph Node Dissection for
More informationProstate Case Scenario 1
Prostate Case Scenario 1 H&P 5/12/16: A 57-year-old Hispanic male presents with frequency of micturition, urinary urgency, and hesitancy associated with a weak stream. Over the past several weeks, he has
More information10/24/2008. Surgery for Well-differentiated Thyroid Carcinoma- The Primary
Surgery for Well-differentiated Thyroid Carcinoma- The Primary Head and Neck Endocrine Surgery Department of Otolaryngology-Head and Neck Surgery, UCSF October 24-25, 2008 Robert A. Sofferman, MD Professor
More informationCase Report Multiple Intracranial Meningiomas: A Review of the Literature and a Case Report
Case Reports in Surgery Volume 2013, Article ID 131962, 4 pages http://dx.doi.org/10.1155/2013/131962 Case Report Multiple Intracranial Meningiomas: A Review of the Literature and a Case Report F. Koech,
More informationResearch Article Epidemiology of Thyroid Cancer in an Area of Epidemic Thyroid Goiter
Cancer Epidemiology Volume 213, Article ID 584768, 4 pages http://dx.doi.org/.1155/213/584768 Research Article Epidemiology of Thyroid Cancer in an Area of Epidemic Thyroid Goiter Antonio Cossu, 1 Mario
More informationThyroid Cancer (Carcinoma)
Information for Patients Thyroid Cancer (Carcinoma) Prepared by the American Association of Clinical Endocrinologists (AACE), a not-for-profit national organization of highly qualified specialists in hormonal
More informationCorrespondence should be addressed to Stan H. M. Van Uum;
Oncology Volume 2016, Article ID 6496750, 6 pages http://dx.doi.org/10.1155/2016/6496750 Research Article Recombinant Human Thyroid Stimulating Hormone versus Thyroid Hormone Withdrawal for Radioactive
More informationThe International Federation of Head and Neck Oncologic Societies. Current Concepts in Head and Neck Surgery and Oncology
The International Federation of Head and Neck Oncologic Societies Current Concepts in Head and Neck Surgery and Oncology www.ifhnos.net The International Federation of Head and Neck Oncologic Societies
More informationProposed All Wales Vulval Cancer Guidelines. Dr Amanda Tristram
Proposed All Wales Vulval Cancer Guidelines Dr Amanda Tristram Previous FIGO staging FIGO Stage Features TNM Ia Lesion confined to vulva with
More informationCase Report Combined Effect of a Locking Plate and Teriparatide for Incomplete Atypical Femoral Fracture: Two Case Reports of Curved Femurs
Case Reports in Orthopedics Volume 2015, Article ID 213614, 5 pages http://dx.doi.org/10.1155/2015/213614 Case Report Combined Effect of a Locking Plate and Teriparatide for Incomplete Atypical Femoral
More informationSARDA AND OTHERS No. of patients (%) Figure 1. Age distribution. Papillary Follicular < > 60 Age at chagnos
Asian Journal of Surgery Excerpta Medica Asia Ltd Prognostic Factors for Well-Differentiated Thyroid Cancer in an Endemic Area A.K. Sarda, Shweta Aggarwal, Durgatosh Pandey, Gagan Gautam, Department of
More informationReview Article Management of papillary and follicular (differentiated) thyroid carcinoma-an update
Bangladesh J Otorhinolaryngol 2010; 16(2): 126-130 Review Article Management of papillary and follicular (differentiated) thyroid carcinoma-an update Md. Abdul Mobin Choudhury 1, Md. Abdul Alim Shaikh
More informationCase Report Synchronous Bilateral Solid Papillary Carcinomas of the Breast
Case Reports in Surgery Volume 2013, Article ID 812129, 4 pages http://dx.doi.org/10.1155/2013/812129 Case Report Synchronous Bilateral Solid Papillary Carcinomas of the Breast Noriko Yoshimura, 1 Shigeru
More informationClinical Study Utility of Surgeon-Performed Ultrasound Assessment of the Lateral Neck for Metastatic Papillary Thyroid Cancer
Oncology Volume 2012, Article ID 973124, 4 pages doi:10.1155/2012/973124 Clinical Study Utility of Surgeon-Performed Ultrasound Assessment of the Lateral Neck for Metastatic Papillary Thyroid Cancer CortneyY.Lee,SamuelK.Snyder,TerryC.Lairmore,SeanC.Dupont,andDanielC.Jupiter
More informationPreoperative Evaluation
Preoperative Evaluation Lateral compartment lymph nodes are easier to detect and are amenable to FNA Central compartment lymph nodes are much more difficult to detect and FNA (Tg washout testing is compromised)
More informationSkull metastasis revealing a papillary thyroid carcinoma
Case Report Skull metastasis revealing a papillary thyroid carcinoma Xi Li 1, Ge Zhao 2, Yong Zhang 3, Kui Ding 1, Hui Cao 1, Dehua Yang 1, Jian Zhang 1, Zhiquan Duan 1, Shijie Xin 1 1 Department of Vascular
More informationExtensive bone metastases as the initial symptom of papillary thyroid microcarcinoma: A case report
2104 Extensive bone metastases as the initial symptom of papillary thyroid microcarcinoma: A case report WEI ZHENG, JIAN TAN and GUIZHI ZHANG Department of Nuclear Medicine, Tianjin Medical University
More informationCase Report Sarcomatoid Renal Cell Carcinoma Metastasis to the Penis
Case Reports in Urology Volume 2015, Article ID 467974, 4 pages http://dx.doi.org/10.1155/2015/467974 Case Report Sarcomatoid Renal Cell Carcinoma Metastasis to the Penis Victor D. Liou, 1 Oussama M. Darwish,
More informationThyroid Cancer: When to Treat? MEGAN R. HAYMART, MD
Thyroid Cancer: When to Treat? MEGAN R. HAYMART, MD ASSOCIATE PROFESSOR OF MEDICINE UNIVERSITY OF MICHIGAN MICHIGAN AACE 2018 ANNUAL MEETING Thyroid Cancer: When Not to Treat? FOCUS WILL BE ON LOW-RISK
More information